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A Year's Gunshot Injuries Cost U.S. Taxpayers more than $1 Billion in Lifetime Medical Costs

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Duke Health News 919-660-1306

DURHAM, N.C. - In 1994, more than 38,000 people in the United States died from gunshots; nearly another 100,000 people were injured. These statistics represent the "enormous human toll of gun violence," and cost U.S. taxpayers more than $1 billion in lifetime medical costs, says a new study that appears in the Aug. 4 issue of The Journal of the American Medical Association (JAMA).

The estimated medical costs of treating fatal and non-fatal gunshot injuries in the United States in 1994 was $2.3 billion, of which $1.1 billion was paid for by taxpayers through government programs, the JAMA article states.

The article's authors -- Philip Cook of Duke University, Bruce Lawrence and Ted Miller of the National Public Services Research Institute in Landover, Md., and Jens Ludwig of Georgetown University -- used hospital discharge figures from Maryland and New York, emergency department records from South Carolina and information from a number of other sources, including the National Spinal Cord Injury Statistical Center, to calculate their findings. The researchers say they primarily used 1994 figures for their study because this data was the most up-to-date and comprehensive available.

The researchers calculated that the mean medical cost per injury was about $17,000, of which 49 percent was paid by taxpayers, 18 percent by private insurance and 33 percent by other sources. "While medical costs are a relatively small component of the total burden imposed on society by gun violence, they represent a substantial cost to the medical system," the article states.

Cook, the director of the Terry Sanford Institute of Public Policy at Duke, said in an interview that many people see gun violence as someone else's problem, that it has nothing to do with them or their circumstances. "But if they are taxpayers, they should be concerned about it, if for no other reason than so much of the cost is shared through government programs and insurance. In that respect, we all share in the pain."

The researchers note in their article that this "study presents what we feel are the first nationally representative estimates for the sources of payments for medical costs that are specific to gunshot injuries."

"While measuring medical costs is not as straightforward as counting the number of victims, valid cost estimates are important for at least two reasons," the authors write. "First, such estimates are relevant to evaluating gun violence-reduction programs. Second, reliable estimates for the financial burden that gun violence imposes on the medical care system may help guide reimbursement policies."

To calculate lifetime medical costs, the researchers measured acute-care hospital costs and follow-up charges that included prescriptions, medical supplies (such as crutches), home health care and follow-up physician visits. While the mean medical cost per injury ran about $17,000 for the 134,445 fatal and non-fatal gunshot injuries in 1994, the non-fatal gunshot injuries that required hospitalization resulted in more than $35,000 per case in lifetime medical costs.

The researchers also determined that: Gunshot injuries due to assaults accounted for 74 percent of the total medical costs. Government programs are the primary payers for 40 percent to 50 percent of hospitalized gunshot injury cases. These same programs are the primary payers for 62.5 percent of spinal injury cases due to gunshots and 88.6 percent of spinal injury cases after initial hospitalization. Non-fatal self-inflicted gunshot injuries have higher lifetime costs that unintentional injuries or assaults. For non-fatal gunshot injury victims, the majority of medical treatment costs come after the patient has been discharged from the hospital.

"We see our estimates as being the lower bound," Cook said in the interview. "There are some costs we were not able to include but which nonetheless add to the cost, such as the cost of treatment for psychological injuries associated with the shooting. We also were not able to take into full account the follow-up costs for brain injuries."

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